Results:

There were 250 patients with definite infectious endocarditis from the study population (1.1% per person-year, 95% confidence interval [CI], 1.1-1.4%). The median time of endocarditis after TAVR was 5.3 months (interquartile range, 1.5-13.4 months). Variables associated with increased risk of infectious endocarditis included younger age (78.9 vs. 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male gender (62.0 vs. 49.7%; HR, 1.69; 95% CI, 1.13-2.52), diabetes mellitus (41.7 vs. 30.0%; HR, 1.52; 95% CI, 1.02-2.29), and ≥ moderate residual aortic regurgitation (22.4 vs. 14.7%; HR, 2.05; 95% CI, 1.28-3.28). Performance of the TAVR procedure in an operating room versus catheterization laboratory (p = 0.47), or the use of a self-expanding versus balloon-expandable valve (p = 0.34) was not associated with a difference in the incidence of endocarditis. The source of endocarditis was intravascular or soft tissue infection in 10.4%, while the source in 69.6% of cases was unknown. Health care-associated endocarditis was seen in 52.8% of cases. The most common causative organisms were enterococci (24.6%), staphylococcus aureus (23.3%), and coagulase-negative staphylococci (16.8%). The in-hospital mortality rate was 36% in patients with endocarditis, with a 2-year mortality rate of 66.7%.